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J Thorac Cardiovasc Surg 2008;135:527-532
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Ten-year experience with single-vessel and multivessel reoperative off-pump coronary artery bypass grafting

Escorts Heart Institute and Research Centre, New Delhi, India

Received for publication April 28, 2007; revisions received October 5, 2007; accepted for publication October 19, 2007.

^_* Address for reprint: Yugal K. Mishra, PhD, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India. (Email: dryugal{at}yahoo.com).

Objective: Patients undergoing reoperative coronary artery bypass have increased mortality and morbidity compared with those undergoing primary coronary bypass. The experience in applying off-pump techniques to coronary reoperations is limited. In this article we report a 10-year experience using various techniques of reoperative off-pump coronary bypass.

Methods: Between January 1996 and December 2005, 332 patients underwent reoperative off-pump coronary artery bypass grafting. Data were collected regarding the preoperative, intraoperative, and postoperative clinical course of all patients. These were compared with similar data obtained from patients who had undergone conventional coronary reoperation during this period.

Results: Two hundred ninety-six (89.2%) male and 36 female patients underwent reoperative off-pump coronary artery bypass. Of these, 265 (79.8%) patients underwent multivessel bypass through a median sternotomy, an anterolateral thoracotomy was performed in 63 (19%) patients, and a posterolateral thoracotomy was performed in 4 (1.2%) patients. The early mortality for patients undergoing off-pump surgery was lower than for those undergoing conventional reoperations (3.3% vs 5.5%, P = .066). Those who had undergone off-pump reoperations had less need for prolonged ventilation or prolonged inotropic support and had shorter intensive care unit and hospital stays than patients who had undergone redo coronary artery bypass grafting.

Conclusion: For many patients requiring coronary reoperations, off-pump techniques are safe and feasible. Complete revascularization was achieved in at least 75% of patients in an unselected population, with mortality and perioperative event rates that are comparable with those of conventionally performed coronary reoperations.